Prospective study of TACE combined with sorafenib vs TACE combined with 125I seed implantation in the treatment of hepatocellular carcinoma with portal vein tumor thrombus and arterioportal fistulas

Xiao-Hui Zhao; Hang Yuan; Wei-Li Xia; Li-Lin Zhang; Zhen Li; Guang-Shao Cao; Hai-Liang Li; Wei-Jun Fan; Hong-Le Li; Chen-Yang Guo; Quan-Jun Yao; Wen-Bo Zhu; Hong-Tao Hu

doi:10.3389/fonc.2022.977462

Prospective study of TACE combined with sorafenib vs TACE combined with ¹²⁵I seed implantation in the treatment of hepatocellular carcinoma with portal vein tumor thrombus and arterioportal fistulas

Front Oncol. 2022 Oct 5:12:977462. doi: 10.3389/fonc.2022.977462. eCollection 2022.

Authors

Xiao-Hui Zhao¹, Hang Yuan¹, Wei-Li Xia¹, Li-Lin Zhang², Zhen Li³, Guang-Shao Cao⁴, Hai-Liang Li¹, Wei-Jun Fan⁵, Hong-Le Li⁶, Chen-Yang Guo¹, Quan-Jun Yao¹, Wen-Bo Zhu¹, Hong-Tao Hu¹

Affiliations

¹ Department of Minimal-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.
² Yangtze University Health Science Center, Jingzhou, China.
³ Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
⁴ Department of Intervention, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
⁵ Imaging and Interventional Department, Sun Yat-sen University Cancer Center, Guangzhou, China.
⁶ The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, China.

Abstract

Purpose: To compare the efficacy of TACE combined with sorafenib and TACE combined with ¹²⁵I seed implantation in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) combined with arterioportal fistulas (APFs), and discuss the efficacy and safety of TACE combined with ¹²⁵I seed implantation.

Patients and methods: Between January 2017 and December 2018, the clinical data of patients with HCC complicated with PVTT and APFs who were admitted to the Affiliated Cancer Hospital of Zhengzhou University, First Affiliated Hospital of Zhengzhou University, and Henan Provincial People's Hospital were prospectively collected. The patients were divided into the TACE+sorafenib (TACE-S) group based on their treatment willingness. There were 26 and 32 patients in the TACE-S and TACE-¹²⁵I groups, respectively. Both groups of patients underwent APFs occlusion during TACE therapy. The embolization effect of APFs was observed and recorded in the two groups, the efficacy of intrahepatic lesions and PVTT was evaluated, and the effects of different treatment methods on the efficacy were analysed.

Results: All patients completed the 3 months follow-up. The improvement rates of APFs in TACE-S and TACE-¹²⁵I groups were 30.77% (8/26) and 68.75% (22/32), respectively, and difference was statistically significant (χ2 = 8.287, P=0.004). The median survival time of TACE-S and TACE-¹²⁵I groups was 8.00 months and 12.8 months, respectively (χ2 = 7.106, P=0.008). Multivariate analysis showed that the PVTT subtype (IIa/IIb) and treatment method (TACE-S or TACE-¹²⁵I) were independent factors affecting the recanalization of APFs in patients (P<0.05).

Conclusion: For patients with HCC with PVTT and APFs, TACE combined with ¹²⁵I seed implantation can effectively treat portal vein tumor thrombus, thereby reducing the recanalization of APFs and prolonging the survival time of patients.

Keywords: 125 I seed; arterioportal fistulas; hepatocellular carcinoma; portal vein tumor thrombus; sorafenib; transarterial chemoembolization.